Provider Demographics
NPI:1669988994
Name:TREGLOAN, MICHELLE ELIZABETH
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:ELIZABETH
Last Name:TREGLOAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1362 W CRYSTAL ST APT 3F
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60642-3300
Mailing Address - Country:US
Mailing Address - Phone:815-275-9406
Mailing Address - Fax:
Practice Address - Street 1:1362 W CRYSTAL ST APT 3F
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60642-3300
Practice Address - Country:US
Practice Address - Phone:815-275-9406
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-22
Last Update Date:2017-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL146.012284235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist